Subject: CPT codes (was Re: stupid insurance companies)

[Guest guest]

Carole,

I was _not_ going to mention any surgeon's names or suggest that his

office falsify records; I wasn't even going to mention it to the

doctor at all. I was merely asking what terminology was used so that

I could present it to the insurance specialist at his office when we

sit down to go through that paperwork as something I'd found in my

research... to make sure I was submitted for the correct surgery in

the best manner to get it approved. I do not want to ruin anything

for anyone, believe me.

However, I also do _not_ have the option of going to another

surgeon. I have been jumping through hoops since July already to get

this far. In addition, I was laid off last week. I don't know how

long I can afford to keep up COBRA, and the likelihood of getting

another insurance that will cover this kind of surgery is slim, so

this doctor and this current opportunity are IT for me.

It's dreadful to be going into this with so much anxiety, but I am

out of time and out of options... so I am going to have to fight for

what I need. I was just asking for a little help in doing so.

And quite frankly, now I want to be one of the patients that proves

to Dr. Scholten that the DS is the far superior procedure with better

long term results than the RNY. Juvenile, maybe...

Anyway, what I was looking for is what you put in your post << the

43848 is for the Long Limb Reu En Y, which is what the DS is >>. By

making sure that THAT is what is submitted to the insurance company,

if I get approved I will know I have been approved for the DS and not

the RNY. Thank you.

Now my question is, if 43846 is the RNY, and 43848 is the long-limb

roux-en-y (DS), then what is 43847, which is what the original poster

on this thread was approved for and was told bravo, don't worry,

you've got it? I'm confused... again. *sigh* Sorry.

I appreciate everyone's tolerance as I go through my pre-consult /

pre-insurance approval panic... this can't be called jitters in any

way, shape or form. ;o)

> In a message dated 12/2/01 5:58:48 AM Eastern Standard Time,

> duodenalswitch@y... writes:

>

> << I'm already gearing up for a fight with the insurance company,

and

> since my surgeon is so pro-RNY, I don't expect much help from that

> quarter. But if I can get them to use wording for the DS on the

LOMN

> that will get it past the reviewer at the insurance company, I may

be

> ahead of the game.

>

> Thanks!

> >>

> - if your surgeon is so pro RNY and you tell him that other DS

surgeons

> are just using the code and calling it something else, he just

might want to

> blow it for everyone and those surgeons. Please do me a favor and

do not

> mention any names of the surgeons involved that have learned how to

deal with

> insurance companies.

> I read somewhere on this list that the code you got approved for is

for

> RNY)43846) but the 43848 is for the Long Limb Reu En Y, which is

what the DS

> is.

> PLEASE if your surgeon is pro RNY, go to another Dr. instead of

asking him to

> change the code and saying other docs do that. He will probably

say they are

> not being honest, but they are - they are just using the correct

code. Seems

> to me like your Doc wants to give you the RNY, and since you will

be out

> during surgery, I sure would want to be able to trust that I'd get

what I

> wanted and that the Doc knows how to do the surgery.

> Carole